Jul 1, 2011 - revealed multiple brownish warty papules and nodules over the left dorsal hand (Figure 1). An incisional biopsy of the plaque was performed ...
DERMATOLOGICA SINICA 30 (2012) 81–82
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Multiple brownish warty papulonodules on left dorsal hand Case report A 56-year-old nonobese man presented with progressive thickening and darkening of the left dorsal hand for 3 months. The patient denied any history of systemic disease, such as diabetes mellitus or other endocrinopathies, and there was no family history of malignancy. He reported no systemic symptoms such
as weight loss, general malaise or melena, with the exception of a 1-month history of low back pain. Physical examination revealed multiple brownish warty papules and nodules over the left dorsal hand (Figure 1). An incisional biopsy of the plaque was performed and histopathological examination demonstrated pronounced hyperkeratosis, acanthosis, and papillomatosis (Figure 2).
Figure 1 Multiple brownish warty papules and nodules around left wrist and dorsal hand.
Figure 2 Histopathological examination demonstrated pronounced hyperkeratosis, acanthosis, and papillomatosis. There were only sparse perivascular and interstitial lymphohistiocytic infiltrates in the dermis.
Figure 3 Gradual and complete regression of skin lesions was observed during the second course of chemotherapy.
1027-8117/$ – see front matter Copyright Ó 2012, Taiwanese Dermatological Association. Published by Elsevier Taiwan LLC. All rights reserved. doi:10.1016/j.dsi.2011.10.004
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Resident’s Forum / Dermatologica Sinica 30 (2012) 81–82
Diagnosis Florid cutaneous papillomatosis (FCP). Discussion The histopathological findings were consistent with acanthosis nigricans. Sudden onset of acanthosis nigricans in a nonobese patient without any systemic disease raises our concern for internal malignancy. The patient was referred to the oncology department and an extensive search for underlying malignancy was initiated. Laboratory evaluation showed anemia, positive stool occult blood, markedly elevated carbohydrate antigen 19-9 (1763.00 U/mL; normal range
